Background: The impact of underlying etiology on outcomes in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) remains poorly defined. We aimed to evaluate etiology–specific differences in outcomes using a nationwide multicenter database. Methods: This retrospective cohort study enrolled consecutive adult patients receiving VA-ECMO for CS from the Chinese Society of Extracorporeal Life Support (CSECLS) registry database between August 2015 and March 2025. Patients were categorized by etiology: fulminant myocarditis, acute myocardial infarction (AMI), unstable angina, postcardiotomy, heart failure, pulmonary embolism, heart transplant, and other. Baseline characteristics, ECMO parameters, and outcomes were compared. Primary endpoint was in–hospital mortality. Results: 6769 patients were included finally. In–hospital mortality differed across etiologies (p<0.001), with highest rates in postcardiotomy (47%). Intra–aortic balloon pump use was highest in AMI and postcardiotomy (40%). Lactate levels were elevated in postcardiotomy (5.3±5.1 mmol/L). ECMO duration was longest in heart transplant (180.4±125.8 h) and shortest in pulmonary embolism (129.9±118.4 h, p<0.001). Significant differences were observed in comorbidities across groups. Conclusion: Clinical outcomes of VA-ECMO patients vary considerably according to the underlying etiology. These findings underscore the importance of etiology–specific risk stratification for clinical decision–making and resource allocation in ECMO programs.
Wang et al. (Mon,) studied this question.
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